title: Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia.
abstract: BACKGROUND
  The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs.
  
  
  OBJECTIVE
  To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization.
  
  
  METHODS
  Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design.
  
  
  RESULTS
  Matched residents with (n=1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n=1924, unique n=4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P=0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference=$1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference=0.34, 0.92 days).
  
  
  CONCLUSIONS
  In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.
authors.affiliation: The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hwang
authors.affiliation: The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Electronic address: jmteno76@mac.com.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.affiliation: The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gozalo
authors.affiliation: Harvard Medical School, Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Mitchell
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D003704:Dementia / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007441:Intubation, Gastrointestinal / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: Feeding tubes; advanced dementia; health care costs